• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.1187-1191
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• 2016

Background: The prevalence of prostate cancer (PCa) has been increasing in recent years. Treatment strategies are largely based on the results of bone scan screening. Therefore, our aim was to investigate predictors of positive bone metastasis in newly diagnosed PCa patients. Materials and Methods: After extensive review, 336 consecutive patients newly diagnosed with PCa between April 2010 and November 2013 at our institution were enlisted in the study. Patients were divided into two groups according to bone scan results. Univariate analyses (Chi-square test for discrete variables and independent t-test for continuous variables) were applied to determine the potentially significant risk factors associated with distant bone metastasis. Binary logistic regression analyses were used to further investigate the influence of these factors on bone metastasis. Results: The patient mean age was $71.9{\pm}8.6years$ (range: 48 to 94 years). The mean prostate specific antigen (PSA) level and biopsy Gleason score were $260.2{\pm}1107.8ng/mL$ and $7.4{\pm}1.5$, respectively. The body mass index (BMI) for the series was $24.5{\pm}3.4kg/m^2$. Sixty-four patients (19.0%) had a positive bone scan result. Patients with positive bone scan results had a significantly lower BMI ($23.3{\pm}3.5$ vs. $24.8{\pm}3.3$; p=0.003), a higher Gleason score ($8.5{\pm}1.1$ vs. $7.1{\pm}1.5$; p < 0.001), and a higher PSA level ($1071.3{\pm}2337.1$ vs. $69.4{\pm}235.5$; p < 0.001) than those without bone metastasis. Multivariate logistic regression analysis employing the above independent predictors demonstrated that a Gleason score of ${\geq}7$, clinical stage ${\geq}T3$, $BMI{\leq}22kg/m^2$, and an initial PSA level of ${\geq}20ng/mL$ were all independent predictors of bone metastasis. Conclusions: A bone scan might be necessary in newly diagnosed PCa patients with any of the following criteria: clinical stage T3 or higher, a Gleason score of 7 or higher, BMI equal to or less than 22, and a PSA level of 20 or higher.

• The Journal of Korean Society for Radiation Therapy
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• 제33권
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• pp.137-144
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• 2021

Purpose : The usability of X-Jaw split VMAT was evaluated by comparative analysis of the dose distribution between the treatment plan divided by X-Jaw and Full field VMAT treatment plan in left breast cancer treatment including supraclavicular lymph nodes. Materials and Methods : 10 patients with left breast cancer, including supraclavicular lymph nodes, were simulated using vacuum cushion, and 2 Full field Arc VMAT and 4 X-Jaw split Arc VMAT were planned The treatment plan was designed to include more than 95% of the Planning Target Volume (PTV) and to be minimally irradiated in the surrounding Organ at risk (OAR). Dose analysis of PTV and OAR was performed through dose volume histogram (DVH). Results : The Full field VMAT treatment plan and the X-Jaw split VMAT treatment plan of 10 patients were expressed as average values and compared. The difference between the two treatment plans was not large, with a Conformity index (CI) of 1.05±0.04, 1.04±0.03, and a Homogeneity index (HI) of 1.07±0.008, 1.07±0.009. For OAR, V5 in the left lung is 56.1±6.50%, 50.4±6.30%, and V20 is 20.0±4.15%, 13.52±3.61%. Compared to Full field VMAT, V5 decreased by 10.0% V20 by 32.6% in X-Jaw split VMAT. The V30 of the heart is 3.68±1.85%, 2.23±1.52%, and the Mean dose is 8.93±1.65 Gy, 7.67±1.52 Gy. In the X-Jaw split VMAT, V30 decreased by 39.3% and the Mean dose decreased by 14.1%. The left lung and heart, which are normal tissues, were found to have a statistical significance of that p-value is less than 0.05. Conclusion : In the case of left breast cancer treatment, which includes Supraclavicular lymph nodes with a large PTV volume and a length of X Jaw of 15 cm or more, the X-Jaw split VMAT shows improved dose distribution, which can reduce radiation dose of OAR such as lungs and heart, while maintaining similar PTV coverage with HI and CI equivalent to Full field VMAT. It is thought to be effective in reducing radiation complications.

• Tuberculosis and Respiratory Diseases
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• 제64권4호
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• pp.318-323
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• 2008

It is difficult to distinguish a lung cancer from a pulmonary tuberculoma or other benign nodule. It is even more difficult to identify the type of lesion if the mass shows no change in size or demonstrates slow growth. Only a pathological confirmation can possibly reveal the nature of the lesion. A 61-year-old-woman was referred for a solitary pulmonary nodule. The nodule showed no change in size for the first two years and continued to grow slowly. Pathological and immunological analyses were conducted for confirmation of the nodule. The nodule was identified as a well-differentiated primary pulmonary adenocarcinoma. An LULobectomy was performed, and the post surgical stage of the nodule was IIIA (T2N2M0). Even though there are few risk factors, there is still the possibility of a malignancy in cases of non-growing or slow growing solitary pulmonary nodules. Therefore, pathological confirmation is encouraged to obtain a firm diagnosis.

• Journal of Preventive Medicine and Public Health
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• 제30권4호
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• pp.697-707
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• 1997

This study was performed to estimate the quantity of the effects of tobacco price raise on the smoking rate, and the smoking attributable deaths in Korea. The data were collected by questionnaire survey from 538 male of male workers. The questionnaire contained items on age, sex, living place, status of education, smoking history, the intention to quit smoking when the tobacco price be raised. The questionnaire, were distributed to the offices of enterprises, hospitals, research centers, and public agencies and then collected. Data were analyzed by using the age specific smoking rate, relative risks of eight major smoking related diseases, vital statistics, and the population attributable risk of deaths of smoking males. On the other hand, the impact of the tobacco price raise on the population attributable risk of death due to smoking in Korea was estimated by applying the presumed smoking rate after the price raise. The results obtained were as follows: 1. The smoking rate of male white color workers in large cities was 59.5%. 2. The proportion of male smokers who has the intention to quit smoking when the tobacco price be raised was 61.5%. 3. The proportion of male smokers who has the intention to quit smoking if the price of tobacco be raised was proportional to the degree of increasing tobacco price. It is estimated that if the tobacco price were raised more than four times as now, the presumed smoking rate goes down as low as 26.7%. If the tobacco price be raised 20% each year, presumed smoking rate is 46.2%. 4. The number of attributable male death of smoking estimated by using 8 major smoking related diseases(lung cancer, laryngeal cancer, esophageal cancer, stomach cancer, pancreatic cancer, cerebrovascular disease, ischemic heart disease, chronic obstructive pulmonary disease) was 25,863 death each year. That is 20.1% of total age over 20 male deaths. 5. f the tobacco price were raised more than four times as now and all smokers who has intention to quit smoking quits smoking, 12,336 lives, or 47.7% of smoking related deaths could be saved. 6. IF the actual practice rate of quitting smoking among male smokers with intention to stop smoking when the price of tobacco be raised is 10%, 25%, or 50%, then the expected decrease of death numbers when the tobacco price were raised more than four times as now can be 1,112, 3,483, 5,796 respectively.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• 제24권2호
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• pp.122-129
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• 2014

Objectives: Because of its properties such as resistance to heat, chemicals and corrosion; tensile strength; sound absorption; and affordable price, asbestos has been widely used as a building material, fire resistant and retardant, thermal and heat insulator, soundproofing material, and electrical insulation. Since the prolonged inhalation of asbestos can cause serious illnesses such as lung cancer, mesothelioma, and asbestosis after an incubation period of 20 to 40 years, the mineral was classified as a Group 1 carcinogen by the International Agency for Research on Cancer, an intergovernmental agency forming part of the World Health Organization. Children and infants are more at risk than are adults if they are exposed to carcinogens, due to aweaker immunity that has not yet been fully developed. Most childcare centers are operated all day and children tend to spend a great amount of time in the centers. This is why it is important for them to be systematically isolated from environments that may expose them to asbestos. Materials: In order to understand both indoor and outdoor hazards to which children may have been exposed, the study focused on actual surveys of asbestos used in childcare centers, paying special attention to slate-roofed buildings in the vicinity of the centers. Results: A survey of a total of 211 childcare centers showed that the buildings of 18.1% of the centers contained asbestos, with 60.53% of the material being found in classroom ceilings. "Tex" was the most used material for ceilings, making up 89.47% of all ceilings. An outdoor survey showed that childcare centers in Daegu Metropolitan City had an average of 143 slate-roof buildings within a distance of 1km. Conclusions: Buildings housing mainly toddlers, children, teenagers and others more vulnerable to the toxicity of asbestos are not subject to asbestos investigation by law. A legal and practical basis for asbestos control is required for such buildings. In particular, housing materials which contain asbestos in day care centers require asbestos control. GIS should be used to identify the location of buildings with slate roofing materials in the vicinity of daycare centers in order to gauge toxicity of exposure to asbestos caused by potential asbestos friability possibility in outdoor conditions.

• Radiation Oncology Journal
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• 제22권1호
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• pp.1-10
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• 2004

Locally advanced (Stage III) non-small cell lung cancer (NSCLC) accounts for approximately one third of all cases of NSCLC. Few patients with locally advanced NSCLC present with disease amenable to curative surgical resection. Historically, these patients were treated with primary thoracic radiation therapy (RT) and had poor long term survival rates, due to both progression of local disease and development on distant metastases. Over the last two decades, the use of multidisciplinary approach has improved the outcome for patients with locally advanced NSCLC. Combined chemoradiotherapy is the most favored approach for treatment of locally advanced unresectable NSCLC. There are two basic treatment protocols for administering combined chemotherapy and radiation, sequential versus concurrent. The rationale for using chemotherapy is to eliminate subclinical metastatic disease while improving local control. Sequential use of chemotherapy followed by radiotherapy has improved median and long term survival compared to radiation therapy alone. This approach appears to decrease the risk of distant metastases,, but local failure rates remain the same as radiation alone. Concurrent chemoradiotherapy has been studied extensively. The potential advantages of this approach may include sensitization of tumor cells to radiation by the administration of chemotherapy, and reduced overall treatment time compared to sequential therapy; which is known to be important for improving local control in radiation biology. This approach Improves survival primarily as a result of improved local control. However, it doesn't seem to decrease the risk of distant metastases probably because concurrent chemoradiation requires dose reductions in chemotherapy due to increased risks of acute morbidity such as acute esophageal toxicity. Although multidisciplinary therapy has led to improved survival rates compared to radiation therapy alone and has become the new standard of care, the optimal therapy of locally advanced NSCLC continues to evolve. The current issues in the multidisciplinary management of locally advanced NSCLC will be reviewed in this report.

• The Journal of Korean Society for Radiation Therapy
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• 제29권1호
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• pp.69-76
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• 2017

Purpose: The purpose of this study was to verify dosimetric results and reproducibility of position during craniospinal irradiation (CSI) using tomotherapy (Accuray Incorporated, USA). Also, by comparing with conventional CSI Technique, we confirmed the efficiency of using a Tomotherapy. Materials and Methods: 10 CSI patients who get tomotherapy participate. Patient-specific quality assurances (QA) for each patient are conducted before treatment. When treating, we took Megavoltage Computed Tomography (MVCT) that range of head and neck before treatment, L spine area after treatment. Also we conducted in-vivo dosimetry to check a scalp dose. Finally, we made a 3D conventional radiation therapy(3D-CRT) of those patients to compare dosimetric differences with tomotherapy treatment planning. Results: V107, V95 of brain is 0 %, 97.2 % in tomotherapy, and 0.3 %, 95.1 % in 3D-CRT. In spine, value of V107, V95 is 0.2 %, 18.6 % in tomotherapy and 89.6 %, 69.9 % in 3D-CRT. Except kidney and lung, tomotherapy reduced normal organ doses than 3D-CRT. The maximum positioning error value of X, Y, Z was 10.2 mm, -8.9 mm, -11.9 mm. Through in-vivo dosimetry, the average of scalp dose was 67.8 % of prescription dose. All patient-specific QA were passed by tolerance value. Conclusion: CSI using tomotherapy had a risk of parallel organ such as lung and kidney because of integral dose in low dose area. However, it demonstrated dosimetric superiority at a target and saved normal organ to reduce high dose. Also results of reproducibility were not exceeded margins that estimated treatment planning and invivo dosimetry showed to reduce scalp dose. Therefore, CSI using tomotherapy is considered to efficient method to make up for 3D-CRT.

• Radiation Oncology Journal
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• 제27권3호
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• pp.133-139
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• 2009

Purpose: This study was designed to analyze the outcome and toxicity of thoracic radiation therapy (TRT) and chemotherapy for patients who suffer with limited-stage small-cell lung cancer (LS-SCLC). Materials and Methods: We retrospectively studied 35 patients with LS-SCLC. TRT was administered once daily (1.8 to 2 Gy per fraction) and it was directed to the primary tumor for a total 50 to 66 Gy in 6 to 7 weeks. The patients received four cycles of etoposide plus cisplatin. TRT was begun on day 1 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm. Results: The median progression-free survival time was 16.5 months (95% confidence interval [CI], 9.0 to 24.1 months) for the sequential arm, and 26.3 months (95% CI, 16.6 to 35.9 months) for the concurrent arm. The 2-year progression-free survival rate was 16.0 percent for the sequential arm and 50.0 percent for the concurrent arm (p=0.0950 by log-rank test). Leukopenia was more severe and more frequent in the concurrent arm than in the sequential arm. However, severe esophagitis was infrequent in both arms. The radiotherapy was interrupted more frequently in the concurrent arm than in the sequential arm due to hematologic toxicities (p=0.001). Conclusion: This study suggests that concurrent TRT with etoposide plus cisplatin is more effective for the treatment of LS-SCLC than sequential TRT. However, there is a significant increase in the risk of toxicities, and radiotherapy was frequently interrupted in the concurrent arm due to hematologic toxicities.

• Radiation Oncology Journal
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• 제18권4호
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• pp.314-320
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• 2000

Purpose :To investigate whether changes in plasma concentrations of transforming growth factor-$\beta$1(TGF-$\beta$1), tumor necrosis factor-alpha (TNF-$\alpha$) and interleukin-6 (IL-6) could be used to identify the development of radiation-induced pneumonitis in the lung cancer patients. Methods and Materials :Seventeen patients with lung cancer (11 NSCLC, 6 SCLC) were enrolled in a prospective study designed to evaluate clinical and molecular biologic correlation of radiation-induced pneumonitis. The study began in May 1998 and completed in July 1999. All patients were treated with radiotherapy with curative intent : 1.8 Gy per day, 5 fractions per week. Serial measurements of plasma TGF-$\beta$1, TNF-$\alpha$ and IL-6 were obtained in all patients before, weekly during radiotherapy and at each follow-up visits after completion of treatment. These measurements were quantified using enzyme linked immunosorbent assay (ELISA). All patients were evaluated for signs and symptoms of pneumonitis at each follow-up visit after completion of radiotherapy. High resolution CT (HRCT) scans were obtained when signs and symptoms of pneumonitis were developed after completion of radiotherapy. Results : Thirteen patients eventually developed signs and symptoms of clinical pneumonitis 씬file four patients did not. TGF-$\beta$ 1 levels were elevated in all 13 patients with pneumonitis, which showed characteristic pattern of elevation (38.45 ng/ml at pretreatment, 13.66 ng/ml during radiotherapy, then 60.63 ng/ml at 2-4 weeks after completion of radiotherapy). The levels of TNF- $\alpha$ and IL-6 were also elevated In the group of patients who developed pneumonitis but the pattern was not characteristic. Conclusions : Changes in plasma TGF$\beta$-1 levels before, during and after radiotherapy appears to be a useful means by which to identify patients at risk for the development of symptomatic pneumonitis. Other cytokines like TNF- $\alpha$ and IL-6 shows no meaningful changes in association with radiation pneumonitis.

• The Journal of Korean Society for Radiation Therapy
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• 제29권1호
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• pp.37-48
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• 2017

Purpose: The most basic conditions of radiation therapy is to prevent unnecessary exposure of normal tissue. The risk factors that are important o evaluate the dose emitted to the lung and heart from radiation therapy for breast cancer. Therefore, comparing the dose factors of a normal tissue according to the radion treatment position and Seeking an effective radiation treatment for breast cancer through the analysis of the correlation relationship. Materials and Methods: Computed tomography was conducted among 30 patients with left breast cancer in supine and prone position. Eclipse Treatment Planning System (Ver.11) was established by computerized treatment planning. Using the DVH compared the incident dose to normal tissue by position. Based on the result, Using the SPSS (ver.18) analyzed the dose in each normal tissue factors and Through the correlation analysis between variables, independent sample test examined the association. Finally The HI, CI value were compared Using the MIRADA RTx (ver. ad 1.6) in the supine, prone position Results: The results of computerized treatment planning of breast cancer in the supine position were V20, $16.5{\pm}2.6%$ and V30, $13.8{\pm}2.2%$ and Mean dose, $779.1{\pm}135.9cGy$ (absolute value). In the prone position it showed in the order $3.1{\pm}2.2%$, $1.8{\pm}1.7%$, $241.4{\pm}138.3cGy$. The prone position showed overall a lower dose. The average radiation dose 537.7 cGy less was exposured. In the case of heart, it showed that V30, $8.1{\pm}2.6%$ and $5.1{\pm}2.5%$, Mean dose, $594.9{\pm}225.3$ and $408{\pm}183.6cGy$ in the order supine, prone position. Results of statistical analysis, Cronbach's Alpha value of reliability analysis index is 0.563. The results of the correlation analysis between variables, position and dose factors of lung is about 0.89 or more, Which means a high correlation. For the heart, on the other hand it is less correlated to V30 (0.488), mean dose (0.418). Finally The results of independent samples t-test, position and dose factors of lung and heart were significantly higher in both the confidence level of 99 %. Conclusion: Radiation therapy is currently being developed state-of-the-art linear accelerator and a variety of treatment plan technology. The basic premise of the development think normal tissue protection around PTV. Of course, if you treat a breast cancer patient is in the prone position it take a lot of time and reproducibility of set-up problems. Nevertheless, As shown in the experiment results it is possible to reduce the dose to enter the lungs and the heart from the prone position. In conclusion, if a sufficient treatment time in the prone position and place correct confirmation will be more effective when the radiation treatment to patient.